HomeMy WebLinkAboutPermit Electrical 2003-4-15
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. 225 FIFTH;lTREET
SPRINGFIELD, QREGON 97477
INSPECTION REQlWST: 726~37(j9
OFFICE: 726-37~9, . ,
.'
EU:C._dCAL PERMIT APPLICATION
'City Job NU~bcrCt?m~ ODd/- 0001 6~)
~' ",~
1. LOCATION OF INSTALLATION
So (a';:) <;-' 'IT <:.. -h:e,. ''I A:
LE~A4DESCRIPTION l"1DZ2B" l~ N\
;L brc:;.cr'\c h. C\\ (\J \\-~ l D 1w
New Residelltial-Single or
. Multi-Family per dwelling unit.
Service Included:
Items Cost
Sm:n
JOB DFtS,Clp:RTION (] . 1000 sq. ft. or less
H. V I't-C K. tl'.,t.E4fdllowina oroiec! as submitted hi&tl\eW~~1 500
zoning, and does not require spec!tq< 19trm-lf!AAtion
Permits are non-transfe.rable amN!.~We. L ~ thereof
If work IS not started wItlun 180 days Zoning 1) ~;,::h )A;,:;-//t'-4 Home or
of issuance or if work is suspe~~ 'for t.f - 15" -{j '3 Modular Dwelling
180 days. d S' """"'-I bervice or Feeder
Autrlonze Ignature ~
$106.00
$ 19.00
$ 50.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
ATTENTIOr)l:Oreg~,' w reqUlres:vou to ~f'1. Installation, Alterations.or
1ol16W~ @l<ll1lpt<adr~~r~ab(.,l8f- 'I}. J/rJlJ Q Relocation:
No~i~icl8ltion C T ose les. e set ~
in OAl*t<g~- . ("~?ffi,~" 200 amps or less ," $ 63.00
0090.'yeu ulay b",~ai,rt, CO,iSSO~%u,d~~,"",,"'" 201 amps to 400 amps' $75.00
C~ -, ,'1i. ~1ffi~delMph~0\ 401 amps to 600 amps $125.00
nU01lberfoHhia Orarnon fUliI!l .. . '., ..1l011 ' 61\!!l''\i!Jlll!itlOOO ampS 'fl1R'E J~~I!'1l(
.si.IPeO(les,.no,(f"..rIC,I.Se"""I1",.s,~e6MOJ.l.",.~J.!:.~~L._ "." . ~ .,.orffI50P~Y1;~W~lM.LLE~ " ,'... - m
li ; IX,?,.}.o p y;;l~,.;~. ., Re"c, onne.c"tr01'l"hn,."" 1,.1 ~\I,flER 1HIS, P, $ , .00
J . f J .1>\ I \ liUhlL.t::\.J UI~'1 . '," ,. . fO .
ExpimtionDate, ' .! D-tI;'NO.".; .. .~f:>!CEOif'iSA31\I'lDONtU
. Const(~onh. Numbel{ib~>3;h~)~G. . , i::i'~~~:;~~~,sAWi~li~~t;;;\~c.~tion .',
"CZ"
. Expiration Datei:' Z'4
, ";1';'-
.~
;":;.. .
; Signature of Supervising Electrician
200 amps or less
201 amps to 400 a.mps
Over 401to'600 ainps
Over 600 ampsor;,10QO volts see
"B" above
$50.00
$69.00
$100.00
PIt~J;J;.?~~~ 4
.;~lJCq:ers N~me .~~ I/e..,'.;l<?( ~ ; Lh . D. Bra~:'vCl~~~~:ion or Extension Per Panel
- > I
Address 35'74J e~;\'Ce};(OJJ/ DeLI- OneCircuif'
O!*JCt{jf1I:~holl Lj ') - ~)4?
OWNER INSTALLATION
The installation is. being made on
property I o-\.vn wl}ichis not int)lnded .
for sale, lease or renL
)
.J (jU
$43.00 LfJ.
Each Additional Circuit or with Service .3 {1O
or Feeder Permit I $ 3.00 .
E. Miscellaneous (Service/feeder not included)
-Each iI1stallation, .'.
Pump 'oriirigation .
Sign/Outline Lighting
Limited EnergyIRes
Limited Energy/Comin
$50.00
$50.00
$25.00
$45.00.
Minimum Elech:icPermit Inspection Fee is S45.00 + Surcharges
. ,()1)
4, SUBTOTALOF ABOVE ~ ~ .
-'T%-'State.S~rch~rge . ti ...3 ,~ ~
'--8'%1\dmmlstratlVe Fee I D h&...;. (,." t1
TOTAL s:? .3' ~
~
RECEIPT FOR PAYMENT
CONSTRUCTION CONTRACTORS BOARD
Received from:~ n./'V'SS' ~ ", ~;,,^~r .)r
License I Enforcement No.: AA 8 ~ Phone ,5<f \ ,9- 'TD -(9 -nO<.
TYPES: General - All Structures D
General - Residential D
Specialty - All ~
Specialty - Residential D
Limited Contractor 0
lnspector 0
FOR:
New License---------------- 0
Renewal--------------------- ~
Reissue---------------------- 0
La te F ee--------------------- 0
Lead Base Paint----------- 0
HIAC App------------------ 0
Enforcement Penalty----- D
Inactivate / Reactivate---- 0
Other 0
Amount Paid:
$-.?\D..
Form of Pavment:
'"
Cash ------------- 0
Check # IJ
Money Order----- 0
Received B; tA ,~ ~
. '"
250 / 256
251 / 257
2-1 I 1-8
~- -~
253 / 259
254 / 260
255 / 261
o Pendino
o .
):Q Effective ~- c9 1-1- 03 ~,.. Q l-{ _~r---
..lsIs Exempt
~....."m '."m
o Non-Exempt
$100 x
$ 20 x
$ 5x
A~~
$50 x
SIO x
$ I x
av::r~ \rr
Cashier's Check------------------ 0
Travelers Check------------------ 0
V isa/MasterCa rd/Discover--~
,
Date L- ~ 10' <:s
(Stall' GIV<: copy to ~W>lOmCL Attach nnginal of receipt 10 money and documcntallon. )
Rl.:t.:C:pl J,)\';
07 !Oa;02
,,_I'"
-'
r
License Number:
License Status:
License Category:
License En~ity:
Name/Address:
Work Phone Number:
Assumed Business Name
First Licensed:
Expiration Date:
Employer Status:
Bond Company Name:
Amount:
Bond Effective To:
Insurance Company Name:
Amount:
Insurance Effective To:
Other License Numbers:
Page 1 of 1
Construction Contractors Board
PO Box 14140
Salem OR 97309-5052
503-378-4621 ext. 4900
10-APR-03
89886
Active
Specialty Contractor/All .
Individual
JAMES T FARMER JR
92863 AL V ADORE ROAD
JUNCTION CITY OR 97448
541-998-6772
FARMERS ELECTRIC REFRIGERATION &
H*
.03/24/1993
03/24/2005
EXEMPT
MID CENTURY INSURANCE CO
$10,000
03/24/2005
ASSURANCE CO OF AMERICA (NY)
$1,000,000
03/24/2004
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00250
ISSUED: 04/11/2003
APPLIED: 04/08/2003
EXPIRES: 10/11/2003
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 5625 E ST
ASSESSO~~r~R<f~9<-egl>7PW~W8s you to
F"'JQJ R,\)', rules adopted by the Oregon Utility
PROJE'NOtl '15hlM~1Cg~r.~~Ef:Yf1lW are set fort~
:_ ,/"'1, ^ D nl::"_t')n1_nn1nthrOllnh OAR ~52-001
Owner: OO~~IilllWA~ain copies of the rules b)
Address: 3fi~<t1JjI)~~: 1$Btu~~1~ OR 97478
:"'/l.-.~,:,..f,:,..+h'" nro~nn Iltilit}' N('\tifi~;::ttion
Center is 1-800-332-23r~ONTRACTO' Wf~ATION I
1 I .
Contractor Type Contractor THIS PER~ltalHALL EE~mf~ficT$lIP~RKPhone
Electrical JAMES T FARMER JR AUTHORIA&'B8'lJNDER THIS 'f-ltffl~A01S NOT 541-915-4883
Mechanical DEAN M SCHULTZ COMMENlJlUUR IS ABAN19~~aoPFJR 541-767-0626
Owner KINTIGH DAVE ANY 180 DAY PERIQD
BUILDING INFORMATION I
Springfield
TYPE OF WORK: Heating System
TYPE OF USE:
New
Residential
VN
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
# of Buildings:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
SETBACKS
I DEVELOPMENT INFORMATION I
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
Pae:e 1 of 3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Description I
Description
Tvpe of Construction
$ Per Sq Ft
Square Footal!e
Total Value of Project
~
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Air Handling Unit Up to 10,000
Furnace - up to 100,000 btu
Heat Pump
Minimum/Adjustment Mechanical
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
Date Pai
$10.00
$4.50
$3.15
$8.00
$12.00
$12.00
$13.00
$4.60
$3.22
$43.00
$3.00
4/8/03
4/8/03
4/8/03
4/8/03
4/8/03
4/8/03
4/8/03
4/11/03
4/11/03
4/11/03
4/11/03
Total Amount Paid
$116.47
I Plan Reviews I
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00250
ISSUED: 04/11/2003
APPLIED: 04/08/2003
EXPIRES: 10/11/2003
VALUE:
Value
Date Calculated
Receipt Number
2200200000000000713
2200200000000000713
2200200000000000713
2200200000000000713
2200200000000000713
2200200000000000713
2200200000000000713
2200200000000000732
2200200000000000732
2200200000000000732
2200200000000000732
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
UleouiredJ nsnections I
1 Rough Mechanical: Prior to Cover
2 Final Mechanical: When all mechanical work is complete.
3 Final Electric: When all electrical work is complete.
4 Rough Electric: Prior to Cover
Pal!e 2 of 3
Status
Issued
CITY OF SPRINGFIELD -
Building/Combination Permit
PERMIT NO: COM2003-00250
ISSUED: 04/11/2003
APPLIED: 04/08/2003
EXPIRES: 10/11/2003
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Pa2e 3 of 3
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
COM2003-00250
COM2003-00250
COM2003-00250
COM2003-00250
Payments:
Type of Payment
Check
Paid By
Description
Add, Alter, Extend Circ
Receipt #: 2200200000000000732
Date: 04/11/2003
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
ROBERT B. ROGERS
Received By
Check Number Confirm No
nJm
2186
Page I of I
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4/11/2003
8:59:53AM
,
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Amount Paid
43.00
3.00
3.22
4.60
Line Item Total:
$53.82
How Received
Amount Paid
In Person
53.82
$53.82
Payment Total:
cRcceipt.rpt